Combination Endoscopic Band Ligation and Sclerotherapy Compared with Endoscopic Band Ligation Alone for the Secondary Prophylaxis of Esophageal Variceal Hemorrhage: A Meta-Analysis
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Endoscopic band ligation (EBL) is the community-accepted standard therapy for the secondary prophylaxis of esophageal variceal hemorrhage. Recent data indicate that combination EBL and sclerotherapy may be a more effective therapy than EBL alone. Yet existing data are conflicting. We therefore performed a meta-analysis to compare the efficacy and safety of EBL and sclerotherapy versus EBL alone for the secondary prophylaxis of esophageal variceal hemorrhage. We performed a systematic review of two computerized databases (MEDLINE and EMBASE) along with manual-searching of published abstracts to identify relevant citations without language restrictions from 1990 to 2002. Eight studies met explicit inclusion criteria. We performed meta-analysis of these studies to pool the relative risk for the following outcomes: esophageal variceal rebleeding, death, number of endoscopic sessions to achieve variceal obliteration, and therapeutic complications. There were no significant differences between EBL and sclerotherapy versus EBL alone in the risk of esophageal variceal rebleeding (RR = 1.05; 95% CI = 0.67–1.64; P = 0.83), death (RR = 0.99; 95% CI = 0.68–1.44; P = 0.96), or number of endoscopic sessions to variceal obliteration (RR = 0.23; 95% CI = 0.055–0.51; P = 0.11). However, the incidence of esophageal stricture formation was significantly higher in the EBL group than in the sclerotherapy group. There is no evidence that the addition of sclerotherapy to endoscopic band ligation changes clinically relevant outcomes (variceal rebleeding, death, time to variceal obliteration) in the secondary prophylaxis of esophageal variceal hemorrhage. Moreover, combination EBL and sclerotherapy had more esophageal stricture formation than EBL alone.
KEY WORDSmeta-analysis esophageal variceal hemorrhage Health Services Research
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- Graham DY, Smith JL: The course of patients after variceal hemorrhage. Gastroenterology 80:800–809, 981Google Scholar
- The North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices: A prospective multicenter study. N Engl J Med 319:983–989, 1988Google Scholar
- Laine L, Cook D: Endoscopic ligation compared with sclerotherapy for treatment of esophageal variceal bleeding. A meta-analysis. Ann Intern Med 123:280–287, 1995Google Scholar
- Reveille RM, Goff JS, Stiegman GV, Stauffer JT: Combination endoscopic variceal ligation (EVL) and low-volume endoscopic sclerotherapy (ES) for bleeding esophageal varices: A faster route to variceal eradication. Gastrointest Endosc 37:243, 1991 (abstr)Google Scholar
- Koutsomanias D: Endoscopic variceal ligation combined with low-volume sclerotherapy: A controlled study. Gastroenterology 102:A835, 1992 (abstr)Google Scholar
- El Khayat HR, Omar MM, Moustafa I: Comparitive evaluation of combined endoscopic variceal ligation together with low volume sclerotherapy versus ligation alone for bleeding esophageal varices. Hepatology 26:138A, 1997 (abstr)Google Scholar
- Argonz J, Kravetz D, Suarez A, et al.: Variceal band ligation and variceal band ligation plus sclerotherapy in the prevention of recurrent variceal bleeding in cirrhotic patients: A randomized, prospective and controlled trial. Gastrointest Endosc 51:151–163, 2000Google Scholar
- Hedges LV, Olkin I: Statistical Methods for Meta-Analysis. San Diego, CA, Academic Press, 1985Google Scholar
- Stata Statistical Software: Release 7.0 [computer program]. College Station, TX: Stata Corporation, 2001Google Scholar
- StatXact 4 for Windows [computer program]. Version 4.0.1. Cambridge, MA: Cytel Software Corporation, 2000Google Scholar